Endovascular Treatment for Acute Mesenteric Ischaemia
Bibliographic record
Abstract
Background: Acute mesenteric ischemia (AMI) is associated with a significant morbidity and mortality. Endovascular techniques have emerged as a viable alternative treatment option to conventional surgery. We performed a systematic review of the literature and meta-analysis of reported outcomes. Methods: Our review conformed to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement standards with the protocol registered in PROSPERO (CRD42016035667). We searched electronic information sources (MEDLINE, EMBASE, CINAHL, CENTRAL) and bibliographic lists of relevant articles to identify studies reporting outcomes of endovascular treatment for AMI of embolic or thrombotic aetiology. We defined 30-day or in-hospital mortality and bowel resection as the primary outcome measures. We used the Newcastle-Ottawa scale to assess the methodological quality of observational studies. We calculated combined overall effect sizes using random effects models; results are reported as the odds ratio (OR) and 95% confidence interval (CI). Results: We identified 19 observational studies reporting on a total of 3362 patients undergoing endovascular treatment for AMI. The pooled estimate of peri-interventional mortality was 0.245 (95% CI 0.197–0.299), that of the requirement for bowel resection 0.326 (95% CI 0.229–0.439), and the pooled estimate for acute kidney injury was 0.132 (95% CI 0.082–0.204). Eight studies reported comparative outcomes of endovascular versus surgical treatment for AMI (endovascular group, 3187 patients; surgical group, 4998 patients). Endovascular therapy was associated with a significantly lower risk of 30-day mortality (odds ratio 0.45, 95% CI 0.30–0.67, P 1⁄40.0001), bowel resection (OR 0.45, 95% CI 0.34–0.59, P < 0.00001) and acute renal failure (OR 0.58, 95% CI 0.49–0.68, P < 0.00001). No differences were identified in septic complications or the development of short bowel syndrome. Conclusions: Endovascular therapy confers improved outcomes compared to conventional surgery, reduced mortality, risk of bowel resection and acute renal failure. An endovascular-first approach should be considered in patients presenting with AMI. Publication History Article published online: 26 April 2021 © 2017. The Arab Journal of Interventional Radiology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/). Thieme Medical and Scientific Publishers Pvt. Ltd. A-12, 2nd Floor, Sector 2, Noida-201301 UP, India
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.010 | 0.030 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.004 | 0.006 |
| Bibliometrics | 0.004 | 0.004 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".